腹腔镜完全腹膜外补片修补与腹腔镜腹腔内补片修补治疗两侧下腹壁切口疝的临床疗效比较  

Comparison of Clinical Efficacy Between Laparoscopic Totally Extraperitoneal Sublay and Laparoscopic Intraperitoneal Onlay Mesh for Treating Incisional Hernia on Both Sides of Lower Abdomen

作　　者：朱江 黄海军 庄云峰 梅虎 朱时雨 杨孟选 Zhu Jiang;Huang Haijun;Zhuang Yunfeng(Department of Abdominal Surgery, Third People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China)

机构地区：[1]新疆维吾尔自治区第三人民医院腹部外科,乌鲁木齐830000 [2]复旦大学附属闵行医院上海市闵行区中心医院胃肠外科,上海201100

出　　处：《中国微创外科杂志》2022年第3期208-212,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-201941)。

摘　　要：目的比较腹腔镜完全腹膜外补片修补术(totally extraperitoneal sublay,TES)与腹腔镜腹腔内补片修补术(intraperitoneal onlay mesh,IPOM)治疗两侧下腹壁切口疝的临床疗效。方法选取2017年5月~2020年5月我院两侧下腹壁切口疝41例,随机分为2组:IPOM组21例,接受IPOM;TES组20例,接受TES。对比分析2组围术期指标(手术时间、术中出血量、引流管放置时间、首次进食时间、术后1周疼痛评分、住院时间、住院费用)、术后短期并发症(切口裂开、术区积液、术区血清肿、急性肠梗阻)和长期并发症(慢性疼痛、慢性不全性肠梗阻、肠漏、疝复发)。结果TES组手术时间[(131.3±16.6)min vs.(78.3±7.8)min,t=-12.950,P=0.000]和术中出血量[(12.8±4.4)ml vs.(10.5±1.5)ml,t=-2.177,P=0.040]显著长于/多于IPOM组,术后1周疼痛评分[(3.1±0.7)分vs.(4.3±0.6)分,t=5.573,P=0.000]、住院费用[(1.36±0.07)万元vs.(3.57±0.35)万元,t=27.392,P=0.000]和术后长期并发症发生率[10.0%(2/20)vs.42.9%(9/21),χ^(2)=5.634,P=0.018]显著低于IPOM组。2组引流管放置时间、首次进食时间、住院时间和术后短期并发症发生率差异均无统计学意义(P>0.05)。结论与IPOM比较,TES治疗两侧下腹壁切口疝使用不同于IPOM的补片和修补方式,在术后1周疼痛评分、住院费用和长期并发症方面具有优势,但TES手术时间长,操作难度大。Objective To compare clinical efficacy between laparoscopic totally extraperitoneal sublay(TES)and laparoscopic intraperitoneal onlay mesh(IPOM)for treating incisional hernia on both sides of lower abdomen.Methods A prospective randomized controlled trial was performed on 41 patients who were diagnosed as having incisional hernia on both sides of lower abdomen in our hospital from May 2017 to May 2020.Two groups were randomly divided:21 patients underwent laparoscopic IPOM(IPOM group)and other 20 patients underwent laparoscopic TES(TES group).The perioperative data(operation time,blood loss,drainage tube removal time,time to first diet,postoperative pain score after 1 week,hospital stay,and hospital costs),incidence of short-term postoperative complications(incision’s postoperative cracking,effusion in surgical area,seroma in surgical area,and acute intestinal obstruction)and long-term postoperative complications(chronic pain,chronic incomplete intestinal obstruction,intestinal leakage,and hernia recurrence)were compared and analyzed.Results The TES group had significantly longer operation time[(131.3±16.6)min vs.(78.3±7.8)min,t=-12.950,P=0.000]and more blood loss[(12.8±4.4)ml vs.(10.5±1.5)ml,t=-2.177,P=0.040]than the IPOM group,but it had significantly less postoperative pain score after 1 week[(3.1±0.7)points vs.(4.3±0.6)points,t=5.573,P=0.000],lower hospital costs[(1.36±0.07)ten thousand yuan vs.(3.57±0.35)ten thousand yuan,t=27.392,P=0.000]and lower incidence of long-term postoperative complications[10.0%(2/20)vs.42.9%(9/21),χ^(2)=5.634,P=0.018].There were not significantly differences in drainage tube removal time,time to first diet,hospital stay and the incidence of short-term postoperative complications between the two groups(P>0.05).ConclusionLaparoscopic TES for treating incisional hernia on both sides of lower abdomen,using different hernia patch and herniorrhaphy method,is superior to laparoscopic IPOM in postoperative pain score after 1 week,hospital costs and incidence of long-term postope

关 键 词：切口疝 腹腔镜 疝修补 疝补片 腹膜外 

分 类 号：R65[医药卫生—外科学]